flower

Vaginal Changes

Impacts of Cancer Treatment on Vaginal Health

Vaginal changes after cancer treatment are common and can affect comfort, intimacy, and everyday life. This may include dryness, pain, or changes related to hormones. Explore information on common symptoms, hormone-related changes, and treatment options to help manage them.

Common Changes 

Especially during or after cancer treatment:

  • Vaginal dryness or a lack of moisture - this may impact sex or other activities of living such as riding a bike, or toileting
  • Discomfort or pain with touch or penetration - (touch may be sexual, hygiene or medical)
  • Changes in sexual desire or sexual arousal
  • Tightness in vaginal or pelvic floor muscles

👉 These experiences are common and valid—and support is available. 

 

Pain & Discomfort

Pain and Discomfort with Sexual Activity

Pain and tightness are often related to two different things - Dryness of the vaginal tissues: Vaginal dryness, and tightness of the pelvic floor muscles: Vaginal tightness. Other factors may play including nerve sensation.

Vaginal Dryness

Dryness is common after cancer treatments, especially when estrogen is reduced. The vagina may become easily irritated, sore, dry, and/or itchy. 

This may impact activities of daily living such as toileting and physical activity, medical exams and procedures, and sexual activity.

Vaginal Tightness 

Tightness is common after cancer treatments, including those that reduce estrogen in the body. The Vagina may become less stretchy, and it can be painful to have anything inserted (penis, toy, finger, speculum, tampon, etc.) This can make sexual experiences and pelvic examinations uncomfortable. 

  • This is common and not something you’re “doing wrong”
  • It can improve with:
    • Relaxation exercises including relaxation breathing
    • Gradual exposure (like dilators or fingers)
    • Continued practice with less pain and more pleasure
    • Building of confidence
    • Support from a professional - such as a pelvic and/or sex therapist

Impact of Cancer Treatment 

In addition to estrogen changes, other cancer treatments can impact sex:

  • Pelvic radiation can cause changes in vaginal elasticity and scar tissue to develop
  • Pelvic surgery can impact blood flow and changes in genital sensation
  • Lymphedema can cause genital swelling or discomfort
  • Scarring from surgery or radiation can impact body image
  • Chemotherapy can impact gonadal function and lower estrogen
  • Treatments can cause fatigue and changes in body image

 

Fear of Pain

  • Even when pain has been treated and activity is no longer painful, we don’t forget that experiences were once painful -  the body can still react by expecting pain and tightening automatically. This creates more tightness and makes penetration more uncomfortable.

If something hurts:

  • Stop—don’t push through pain
  • Pain experiences can lead to increased anxiety or fear over time
  • Pain makes sexual activity less rewarding, which also reduces sexual desire
kitten in jar
couple

I thought the pain would improve with time, so I kept pushing through. Instead, it affected both me and my partner. Taking a break from penetrative sex gave us both relief. It allowed me to focus on treatment while we rediscovered closeness and intimacy in other ways.

Rupi (thyroid cancer, 52 years old)

Managing Vaginal Dryness & Discomfort

There are many options—you can mix and match what works for you.

During sexual activity

female-reproductive-system-concept-with-red-flower


Vaginal pain for reasons other than dryness

- Vaginal tissues may also be tight
- Pelvic floor muscles may be over-activated
- Tissues may be sensitive
- Pain can also happen at the back of the vagina - where insertion is too deep
- Sometimes avoiding penetrative sex, or using tools to make penetration less deep can be helpful

Learn how to use the OhNut for depth related pain
  • For the time that you are working on vaginal health (treating dryness or tightness) you might chose to opt out of intercourse or penetration
  • Focus on external pleasurable touch to the vulva and/or clitoris
  • You may be interested in trying some external toys, to enhance sexual stimulation 
  • For more information, watch this video on selecting a vibrator
  • Pelvic floor physiotherapy is an important part of managing pain and vaginal tightness
  • Tight muscles are not strong muscles
  • Instead of focusing on tightening - the focus is on relaxing tight muscles
  • For more information, see our section on pelvic floor physiotherapy

Genital Pain at Other Times:

If you experience pain with activity of daily living (e.g. leisure, exercise, toileting) you may find a lubricant or barrier (e.g. aquaphor, vaseline) helps with this too.

coconut moisturizer

Ongoing care for vaginal health

If vaginal pain is largely related to vaginal health changes such as dryness - theres are some treatments that might be helpful

  • Vaginal moisturizers (used regularly, not during sex)
  • Estrogen hormone therapy (if appropriate for you—talk to a healthcare provider)
  • Topical estrogen (now largely considered very safe and more commonly used)
  • Natural oils (like coconut oil—note: not safe with condoms or some toys)

đź’ˇ Think of this like skincare for your vulva and vagina

  • Lubricants (these don’t treat the vaginal tissue, but are commonly used during sexual activity to reduce friction and pain)

For more detailed information on these treatments, see the Vaginal Therapies page.

hands
Runner

Running is my favourite thing, and after treatment I was grateful to have the energy to return to it. I never expected vaginal discomfort to be the challenge. Dryness and friction made running uncomfortable, but using a silicone lubricant before exercise helped reduce discomfort and allowed me to keep doing what I love.

Lin (breast cancer, 44 years old)